MED-SURG NGN CERTIFICATION
EXAM QUESTIONS AND VERIFIED
ANSWERS 2026
▶ The red reflex is elicited by shining a light in the eyes of the infant at an
angle with the light about 15 in. away. The nurse practitioner is screening
for?
A) Cataracts
B) Strabismus
C) Blindness
D) The blinking response. Answer: A) Cataracts
Screening for cataracts is performed by shining a light into the eyes at an
angle, approximately 15 inches away. If the red reflex is not elicited, then
cataracts are present.
▶ A 44-year-old patient with Down syndrome starts to develop impaired
memory and difficulty with his usual daily life routines. He is having
problems functioning at the job that he has done for the past 10 years. The
physical exam and routine labs are all negative. The vital signs are normal.
His appetite is normal. The most likely diagnosis is:
A) Tic douloureux
B) A stroke
C) Alzheimer's disease
D) Delirium. Answer: C) Alzheimer's disease
Delirium is an acute decline in mental status and is temporary. Common
causes are fever, shock, drugs, alcohol, and dehydration. Alzheimer's
disease is a permanent change to the brain that causes short-term memory
loss, agnosia, apraxia, and aphasia. In this case, the patient's physical
exam is normal; however, he is having memory loss and difficulty working
and carrying out his normal tasks
,▶ Which of the following findings is associated with the chronic use of
chewing tobacco?
A) Cheilosis and xerostomia
B) Glossitis
C) A geographic tongue
D) Leukoplakia and oral cancer. Answer: D) Leukoplakia and oral cancer
The chronic use of tobacco increases the risk of oral cancer and
leukoplakia. Cheilosis is skin fissures/maceration in the corner of the
mouth, most commonly caused by anemia, bacterial infection, vitamin
deficiencies, or oversalivation.
▶ Which of the following is recommended treatment for erythema migrans
or early Lyme disease?
A) Doxycycline (Vibramycin) 100 mg PO BID x 21 days
B) Ciprofloxacin (Cipro) 250 mg PO BID x 14 days
C) Erythromycin (E-mycin) 333 mg PO TID x 10 days
D) Dicloxacillin 500 mg PO BID x 10 days. Answer: A) Doxycycline
(Vibramycin) 100 mg PO BID x 21 days
The CDC-recom- mended treatment for erythema migrans or Lyme disease
is doxycycline 100 mg PO BID x 21 days.
▶ Nurse practitioners and clinical nurse specialists derive their legal right to
practice from:
A) The Nurse Practice Act of the state where they practice
B) The laws of the state where they practice
C) The Medicare statute
D) The Board of Nursing in the state where they practice. Answer: A) The
Nurse Practice Act of the state where they practice
The Nurse Practice Act provides nurses with the legal right to practice
nursing. The State Board of Nursing is the agency that enforces the Nurse
Practice Act. The Medicare statute provides the funds for paying for health
services at the age of 65 years and older.
,▶ You are checking a 75-year-old woman's breast during an annual
gynecologi- cal exam. The left nipple and areola are scaly and reddened.
The patient denies pain and pruritis. She has noticed this scaliness on her
left nipple for the past 8 months. Her dermatologist gave her a potent
topical steroid, which she used twice a day for 1 month. The patient never
went back for the follow-up. She still has the rash and wants an evaluation.
Which of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it
twice a day for 4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise her to stop using soap on both breasts when she bathes to avoid
drying
up the skin on her areolae and nipples
D) Order a sonogram and fine-needle biopsy of the breast. Answer: B)
Order a mammogram and refer the patient to a breast surgeon
A scaly, reddened rash on the breast that does not resolve after a few
weeks of medical treatment may indicate breast cancer. She should have a
mammogram performed and see a breast surgeon for evaluation and
treatment.
▶ The following children are considered at higher risk for tuberculosis (TB)
except:
A) A child who has recently been diagnosed with leukemia
B) An infant whose family is homeless
C) A child who was born in Japan
D) A Hispanic child with asthma who is using a steroid inhaler. Answer: C)
A child who was born in Japan
Risk factors for tuberculosis include compromised immune system, high-
risk populations (minorities, foreign-born people, prisoners, nursing home
residents, indigents, migrant workers and health care providers). Steroid
therapy and blood disorders also increase the risk of TB.
▶ During a sports physical exam of a 14-year-old high school athlete, the
nurse practitioner notices a split of the S2 component of the heart sound
during deep inspiration. She notes that it disappears upon expiration. The
, heart rate is regular and no murmurs are auscultated. Which of the
following is correct?
A) This is an abnormal finding and should be evaluated further by a
cardiologist
B) A stress test should be ordered
C) This is a normal finding in some young athletes
D) An echocardiogram should be ordered. Answer: C) This is a normal
finding in some young athletes
It is common to hear a split of the S2 over the pulmonic area of the heart
with inspiration as long as it disappears with expiration, with no other
abnormal symptoms. This is caused by split- ting of the aortic and pulmonic
components.
▶ Mrs. J. L. is a 55-year-old female with a body mass index (BMI) of 24
and a history of asthma. She has hypertension that has been under control
with hydrochlorothiazide 12.5 mg PO daily. Her total cholesterol is 230 g/dl.
How many risk factors for coronary heart disease (CAD) does she have?
A) 1 risk factor
B) 2 risk factors
C) 3 risk factors
D) 4 risk factors. Answer: C) 3 risk factors
Risk factors for coronary heart disease include hypertension,
hypercholesterolemia, and women 55 years of age and older
▶ A common side effect of metformin (Glucophage) therapy is:
A) Weight gain
B) Lactic acidosis
C) Hypoglycemic episodes
D) Gastrointestinal problems. Answer: D) Gastrointestinal problems
Common side effects of metformin include diarrhea/gastrointestinal
problems.
EXAM QUESTIONS AND VERIFIED
ANSWERS 2026
▶ The red reflex is elicited by shining a light in the eyes of the infant at an
angle with the light about 15 in. away. The nurse practitioner is screening
for?
A) Cataracts
B) Strabismus
C) Blindness
D) The blinking response. Answer: A) Cataracts
Screening for cataracts is performed by shining a light into the eyes at an
angle, approximately 15 inches away. If the red reflex is not elicited, then
cataracts are present.
▶ A 44-year-old patient with Down syndrome starts to develop impaired
memory and difficulty with his usual daily life routines. He is having
problems functioning at the job that he has done for the past 10 years. The
physical exam and routine labs are all negative. The vital signs are normal.
His appetite is normal. The most likely diagnosis is:
A) Tic douloureux
B) A stroke
C) Alzheimer's disease
D) Delirium. Answer: C) Alzheimer's disease
Delirium is an acute decline in mental status and is temporary. Common
causes are fever, shock, drugs, alcohol, and dehydration. Alzheimer's
disease is a permanent change to the brain that causes short-term memory
loss, agnosia, apraxia, and aphasia. In this case, the patient's physical
exam is normal; however, he is having memory loss and difficulty working
and carrying out his normal tasks
,▶ Which of the following findings is associated with the chronic use of
chewing tobacco?
A) Cheilosis and xerostomia
B) Glossitis
C) A geographic tongue
D) Leukoplakia and oral cancer. Answer: D) Leukoplakia and oral cancer
The chronic use of tobacco increases the risk of oral cancer and
leukoplakia. Cheilosis is skin fissures/maceration in the corner of the
mouth, most commonly caused by anemia, bacterial infection, vitamin
deficiencies, or oversalivation.
▶ Which of the following is recommended treatment for erythema migrans
or early Lyme disease?
A) Doxycycline (Vibramycin) 100 mg PO BID x 21 days
B) Ciprofloxacin (Cipro) 250 mg PO BID x 14 days
C) Erythromycin (E-mycin) 333 mg PO TID x 10 days
D) Dicloxacillin 500 mg PO BID x 10 days. Answer: A) Doxycycline
(Vibramycin) 100 mg PO BID x 21 days
The CDC-recom- mended treatment for erythema migrans or Lyme disease
is doxycycline 100 mg PO BID x 21 days.
▶ Nurse practitioners and clinical nurse specialists derive their legal right to
practice from:
A) The Nurse Practice Act of the state where they practice
B) The laws of the state where they practice
C) The Medicare statute
D) The Board of Nursing in the state where they practice. Answer: A) The
Nurse Practice Act of the state where they practice
The Nurse Practice Act provides nurses with the legal right to practice
nursing. The State Board of Nursing is the agency that enforces the Nurse
Practice Act. The Medicare statute provides the funds for paying for health
services at the age of 65 years and older.
,▶ You are checking a 75-year-old woman's breast during an annual
gynecologi- cal exam. The left nipple and areola are scaly and reddened.
The patient denies pain and pruritis. She has noticed this scaliness on her
left nipple for the past 8 months. Her dermatologist gave her a potent
topical steroid, which she used twice a day for 1 month. The patient never
went back for the follow-up. She still has the rash and wants an evaluation.
Which of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it
twice a day for 4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise her to stop using soap on both breasts when she bathes to avoid
drying
up the skin on her areolae and nipples
D) Order a sonogram and fine-needle biopsy of the breast. Answer: B)
Order a mammogram and refer the patient to a breast surgeon
A scaly, reddened rash on the breast that does not resolve after a few
weeks of medical treatment may indicate breast cancer. She should have a
mammogram performed and see a breast surgeon for evaluation and
treatment.
▶ The following children are considered at higher risk for tuberculosis (TB)
except:
A) A child who has recently been diagnosed with leukemia
B) An infant whose family is homeless
C) A child who was born in Japan
D) A Hispanic child with asthma who is using a steroid inhaler. Answer: C)
A child who was born in Japan
Risk factors for tuberculosis include compromised immune system, high-
risk populations (minorities, foreign-born people, prisoners, nursing home
residents, indigents, migrant workers and health care providers). Steroid
therapy and blood disorders also increase the risk of TB.
▶ During a sports physical exam of a 14-year-old high school athlete, the
nurse practitioner notices a split of the S2 component of the heart sound
during deep inspiration. She notes that it disappears upon expiration. The
, heart rate is regular and no murmurs are auscultated. Which of the
following is correct?
A) This is an abnormal finding and should be evaluated further by a
cardiologist
B) A stress test should be ordered
C) This is a normal finding in some young athletes
D) An echocardiogram should be ordered. Answer: C) This is a normal
finding in some young athletes
It is common to hear a split of the S2 over the pulmonic area of the heart
with inspiration as long as it disappears with expiration, with no other
abnormal symptoms. This is caused by split- ting of the aortic and pulmonic
components.
▶ Mrs. J. L. is a 55-year-old female with a body mass index (BMI) of 24
and a history of asthma. She has hypertension that has been under control
with hydrochlorothiazide 12.5 mg PO daily. Her total cholesterol is 230 g/dl.
How many risk factors for coronary heart disease (CAD) does she have?
A) 1 risk factor
B) 2 risk factors
C) 3 risk factors
D) 4 risk factors. Answer: C) 3 risk factors
Risk factors for coronary heart disease include hypertension,
hypercholesterolemia, and women 55 years of age and older
▶ A common side effect of metformin (Glucophage) therapy is:
A) Weight gain
B) Lactic acidosis
C) Hypoglycemic episodes
D) Gastrointestinal problems. Answer: D) Gastrointestinal problems
Common side effects of metformin include diarrhea/gastrointestinal
problems.
